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CASE VI.

R. H., Esq., was a member of the bar, somewhere about middle age. I had the satisfaction of attending him in consultation with Dr. Watson and Mr. Barker, when I was informed that he had been getting thin and emaciated during a period of about twelve months. His appearance and symptoms were very remarkable. He was certainly thin, but not strikingly emaciated, and the surface was soft, loose and supple. He was greatly anæmiated; his eyes were pearly; he complained of extreme languor and faintness; his pulse, contrary to what is usual in capsular disease, was of good size, but exquisitely soft and compressible; the impulse of the heart was feeble, and palpitation or throbbing with scrobicular pulsation was immediately produced by the slightest exertion; without pain, the stomach was exceedingly irritable, and vomiting was both urgent and distressing.

With these symptoms, the surface generally presented a dark dingy aspect, and there were observed, chiefly on the face, neck and arms, patches of a rather deep chestnut-brown colour; these chestnut-brown patches were of various sizes and shapes, and were associated here and there with others presenting a singularly white or blanched appearance, arising either in consequence of the latter portions of the integument having remained unaffected, and so contrasting with the surrounding discoloration, or, what is more probable, from their having received a less supply of pigment than natural. A patient inquiry and most careful examination failed to elicit any information, or to detect any lesion, sufficient to afford even a plausible explanation of the patient’s singular condition. The violent vomiting pointed to organic, perhaps carcinomatous, disease of the stomach; nevertheless the general condition and

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